| Aim: The aim of this study is to provide an more ideal anesthesia method for the subtotalparathyroidectomy of uremic patients with secondary hyperparathyroidism by observing andcomparing the advantages and disadvantages of the single general anesthesia with the generalanesthesia plus cervical plexus block. Methods:60patients(ASA Ⅲ～Ⅳ) undergoing subtotalparathyroidectomy were randomly divided into three groups with20patients in each group:general anesthesia (GA group),general anesthesia plus bilateral superficial cervical plexus block(BSCPB group) and general anesthesia plus combined bilateral deep and superficial cervicalplexus block (BDSCPB group). Anesthesia was induced with midazolam0.03mg/kg, propofol2mg/kg, fentanyl2ug/kg, and cis-Atracurium0.2ug/kg. In the BSCPB group and the BDSCPBgroup, the cervical plexus blockade was performed after endotracheal intubation. The generalanesthesia was maintained by continuing injection of propofol and remifentanil by infusionpump. The dosage of propofol and remifentanil is adjusted according to hemodynamic changes.PCIA was used postoperatively. The hemodynamic parameters and the levels of neuroendocrinestress hormones were monitored and recorded intermittently at the different time points of theperioperative period; the time of the pulling out the tracheal catheter after operation, theincidences of agitation before and after extubation, and the cumulative amount of generalanesthetics were also observed and recorded; at the time points of1h,4h,8h,16h and24h afteroperation, the hemodynamic parameters, VAS and the Ramsay sedation score were recorded;we also recorded the incidences of adverse reaction within postoperative24hours; otherwise thesatisfaction degrees of the patients to anesthesia were also inquired. Results: The relativeindicators of the hemodynamics and the levels of the neuroendocrine stress hormone of thepatients in GA group at the different time points of the perioperative period were higher thanbaseline, while these indicators of the patients in BSCPB group were also increased obviously (P<0.05) when parathyroid was pulled and the Gley’s glands were isolated, which were markedlydifferent from those of the patients in BDSCPB group(P <0.05) at the same time point; the timeof pulling out the tracheal catheter of the postoperative patients, the incidences of agitationbefore and after extubation, and the cumulative amount of general anesthetics of the patients inBSCPB group and BDSCPB group were significantly different from those of the GA group(P<0.01orP<0.05); and the levels of the neuroendocrine stress hormone of the patients in BSCPBgroup and BDSCPB group at the right time points of1h,4h and8h after operation wereobviously lower than those of the GA group (P <0.01orP<0.05), while Ramsay sedation scorewas higher than that of the GA group (P <0.01); the incidences of adverse reactions of thepatients in BSCPB group and BDSCPB group within postoperative24h were significantly lowerthan those of the GA group (P<0.01), while the patients’ satisfaction with anesthesia was higher than that of the GA group (P <0.05). Conclusion: During the subtotal parathyroidectomy foruremic patients with secondary hyperparathyroidism, the general anesthesia plus cervical plexusblock can maintain the perioperative hemodynamic stability better, inhibit the stress responseeffectively, reduce the amount of general anesthetics, lower the incidences of agitation during therecovery period of the anesthesia, shorten the postoperative patients’ awaking time and theextubation time, ease the pain degrees of the postoperative patients, decrease postoperativeanalgesic consumption and the incidences of adverse reactions,therefore, lesser the affection onthe basic illiness of the patient, improve the postoperative patients’ recovery qualities and thepatients’ satisfaction degrees to anesthesia. This method turns out to be simple, effective, safeand reliable, so it is an more ideal anesthesia method, while GA plus BDSCPB is more superior. |
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